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@ARTICLE{Hedstrm:170464,
      author       = {A. K. Hedström and J. Huang and N. Brenner$^*$ and J.
                      Butt$^*$ and I. Kockum and T. Waterboer$^*$ and T. Olsson
                      and L. Alfredsson},
      title        = {{L}ow sun exposure acts synergistically with high {EBNA}-1
                      antibody levels in {MS} etiology.},
      journal      = {European journal of neurology},
      volume       = {28},
      number       = {12},
      issn         = {1351-5101},
      address      = {Oxford [u.a.]},
      publisher    = {Wiley-Blackwell},
      reportid     = {DKFZ-2021-01957},
      pages        = {4146-4152},
      year         = {2021},
      note         = {2021 Dec;28(12):4146-4152},
      abstract     = {Among multiple sclerosis (MS) patients, an association has
                      been observed between low levels of vitamin D and high
                      Epstein-Barr nuclear antigen 1 (EBNA-1) antibody levels.
                      However, whether sun exposure/vitamin D moderates the role
                      of Epstein-Barr virus infection in MS etiology is unclear.
                      We aimed to investigate potential synergistic effects
                      between low sun exposure and elevated EBNA-1 antibody levels
                      regarding MS risk.We used a population-based case-control
                      study involving 2017 incident cases of MS and 2443 matched
                      controls. We used logistic regression models to calculate
                      odds ratios of MS with $95\%$ confidence intervals (CI) in
                      subjects with different sun exposure habits and EBNA-1
                      status. Potential interaction on the additive scale was
                      evaluated by calculating the attributable proportion due to
                      interaction (AP).Low sun exposure acted synergistically with
                      high EBNA-1 antibody levels (AP 0.2, $95\%$ CI 0.03-0.3) in
                      its association to increased MS risk. The interaction was
                      present regardless of HLA-DRB1*15:01 status.Low sun exposure
                      may either directly, or indirectly by affecting vitamin D
                      levels, synergistically reinforce pathogenic mechanisms,
                      such as aspects of the adaptive immune response, related to
                      MS risk conveyed by EBV infection.},
      cin          = {F022 / F020},
      ddc          = {610},
      cid          = {I:(DE-He78)F022-20160331 / I:(DE-He78)F020-20160331},
      pnm          = {316 - Infektionen, Entzündung und Krebs (POF4-316)},
      pid          = {G:(DE-HGF)POF4-316},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34435414},
      doi          = {10.1111/ene.15082},
      url          = {https://inrepo02.dkfz.de/record/170464},
}